An innovative technique for endoscopic submucosal dissection of early gastric cancer using a new spring device

Background and study aims: In recent years, endoscopic submucosal dissection (ESD) has been applied for the treatment of gastric tumors, and the en-bloc resection rate of early gastric cancer has greatly improved. Herein, we introduce spring-assisted ESD, for quicker submucosal dissection.

Patients and methods: ESD was carried out in 32 patients (20 men, 12 women; mean age 72.6 years, range 53 – 88 years) for early gastric cancer, with tumors over 10 mm in diameter. The patients were divided retrospectively into two groups (spring-assisted ESD, n = 20; conventional ESD, n = 12). To comparatively evaluate the performance speed of ESD, the circumferential length and the area of the resected specimen were calculated by the approximation formula for ellipse. Then, the circumferential cutting speed, the submucosal dissection speed, and the total ESD speed were calculated as index scores. The scores for spring-assisted ESD and conventional ESD were compared.

Results: The mean (±SD) circumferential cutting speeds in spring-assisted ESD and conventional ESD were 0.53 ± 0.27 and 0.60 ± 0.30 cm/minute, respectively (P = 0.51). The mean submucosal dissection speeds in spring-assisted ESD and conventional ESD were 0.67 ± 0.41 and 0.32 ± 0.24 cm²/minute, respectively (P = 0.005). The mean total ESD speeds in spring-assisted ESD and conventional ESD were 0.25 ± 0.10 and 0.17 ± 0.07 cm²/minute, respectively (P = 0.015). The mean total ESD times were 57 and 75 minutes in the spring and conventional group, respectively (P = 0.30).

Conclusion: Using the aforementioned indices, we evaluated the performance speed of ESD. Spring-assisted ESD may allow faster submucosal dissection.

References

• 1 Gotoda T, Yanagisawa A, Sasako M. et al . Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two centers.  Gastric Cancer. 2000;  3 219-225
• 2 Gotoda T. Endoscopic diagnosis and treatment for early gastric cancer.  Cancer Reviews: Asia-Pacific. 2004;  2 17-37
• 3 Tanaka M, Ono H, Hasuike N, Takizawa K. Endoscopic submucosal dissection of early gastric cancer.  Digestion. 2008;  77 Suppl 1 23-28
• 4 Matsushita M, Hajiro K, Okazaki K, Takakuwa H. Endoscopic mucosal resection of gastric tumors located in the lesser curvature of the upper third of the stomach.  Gastrointest Endosc. 1997;  45 512-515
• 5 Ono H, Kondo H, Gotoda T. et al . Endoscopic mucosal resection for treatment of early gastric cancer.  Gut. 2001;  48 225-229
• 6 Tanabe S, Koizumi W, Mitomi H. et al . Clinical outcome of endoscopic aspiration mucosectomy for early stage gastric cancer.  Gastrointest Endosc. 2002;  56 708-713
• 7 Rembacken B J, Gotoda T, Fujii T, Axon A T. Endoscopic mucosal resection.  Endoscopy. 2001;  33 709-718
• 8 Yamamoto H, Kawata H, Sunada K. et al . Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood.  Endoscopy. 2003;  35 690-694
• 9 Kuwano H, Mochiki E, Asao T. et al . Double endoscopic intraluminal operation for upper digestive tract diseases: proposal of a novel procedure.  Ann Surg. 2004;  239 22-27
• 10 Kondo H, Gotoda T, Ono H. et al . Percutaneous traction-assisted EMR by using an insulation-tipped electrosurgical knife for early stage gastric cancer.  Gastrointest Endosc. 2004;  59 284-288
• 11 Kobayashi T, Gotohda T, Tamakawa K. et al . Magnetic anchor for more effective endoscopic mucosal resection.  Jpn J Clin Oncol. 2004;  34 118-123
• 12 Imaeda H, Iwao Y, Ogata H. et al . A new technique for endoscopic submucosal dissection for early gastric cancer using an external grasping forceps.  Endoscopy. 2006;  38 1007-1010